On a warm and sunny Wednesday afternoon in downtown Anchorage, two men leaned against the outside wall of Bean's Cafe. Their eyes were closed, mouths open, arms hanging limp. Their heads and torsos swayed side to side as employees gathered nearby. An ambulance was on the way.
"Once I see their eyes roll back in their heads, I always call 911," said Andre Boyd, a monitor at the nonprofit, who on Wednesday made the call that brought medics to the agency within minutes. The two men had smoked the synthetic drug Spice, Boyd said.
As the ambulance arrived, one man opened his eyes and with a startled look reached toward the other man, but he did not respond.
Medics wrapped one man in a sheet and laid him on a stretcher; the other was monitored for vital signs before medics led him to an ambulance.
"The people who walk away, they're the lucky ones," Bean's executive director Lisa Sauder said Wednesday as she watched what has become a familiar scene at the social services organization.
Since mid-summer, medical emergencies stemming from suspected use of the drug have increased drastically in Anchorage, and as winter approaches there seems to be little relief for the city.
From July 18 to Sept. 27, suspected Spice use comprised 10 percent of all Anchorage Fire Department emergency transports, according to data provided by Erich Scheunemann, assistant chief of emergency medical service operations. Three-quarters of the calls came from downtown.
"Anecdotally, we see much more Spice now than meth and heroin combined," Scheunemann said.
Boyd said the 911 dispatchers recognize him by name; some recognize his phone number.
Facing an ongoing battle, the city is grasping for ways to combat the issue.
So far, police have had little power to stall the sale or use of the drug. Possessing and selling Spice is not a crime -- the $500 fine is a civil violation, akin to a traffic ticket, and no criminal charges can be filed unless police can prove criminal intent, a tricky endeavor.
That's because the chemical compounds in the drug are ever-changing; outlaw one compound and another is introduced. The state imposed a $500 fine for selling or possessing Spice last year, but the drug remains legal and easy to import.
On Friday, city officials hinted at solutions on the horizon that may beef up enforcement power, allowing police to make criminal charges around Spice. The city is also asking for help from federal authorities.
'Its been a long time since Ive seen anything like this'
Since Spice cases exploded in mid-July, emergency calls fluctuate day by day. Calls peaked in early August, then again on Aug. 20, before settling down for much of September. But as the last weekend in September approached, the numbers shot back up again.
"It's been a long time since I've seen anything like this," said David Cadogan, emergency room physician and chief medical officer at Alaska Regional Hospital.
Symptoms manifest across a spectrum, Cadogan said. On one end, patients arrive heavily sedated and unresponsive. On the other end, patients are agitated and combative, Cadogan said.
Some days are worse than others. There may be a slow trickle of patients one day and a deluge the next. "One evening we had, I think, six patients within an hour," Cadogan said.
Many involve people Anchorage police call "high-risk" -- including the homeless and people with addictions. The homeless population has been hit disproportionately in this wave of emergency calls, Cadogan said.
Part of the reason is the cost. The drug sells for $5 to $10 a "stick," essentially a Spice cigarette, Boyd said.
Alaska is not alone in dealing with this issue. Nationwide, emergency calls related to the drug have topped 6,000 this year -- almost as many as the previous two years combined, according to the American Association of Poison Control Centers.
The state Department of Health and Social Services is attempting to analyze the problem, but had little new information on its investigations since asked in mid-August. Preliminary patient chart reviews have given way to "more methodical reviews." Preliminary autopsy tests have led to more testing, said state epidemiologist Louisa Castrodale.
For some patients, the ER is a revolving door. "We had two yesterday that came in with a mild intoxication … they came back that same evening … and were even more symptomatic," Cadogan said.
At Bean's, the continuing problem is diverting resources away from the agency's other focuses, Sauder said.
"It's really frustrating and it's heartbreaking," Sauder said.
Seeking solutions
Sauder hopes that changes to city law and investments in more treatment centers could help.
"I'd like to see some teeth to the law … some more detox and treatment options. Because we kind of have a perfect storm," Sauder said.
Bean's isn't the only agency that's diverting its resources to combat Spice. At the Anchorage Police Department, two officers normally slated for patrol have been reassigned to work with undercover detectives on the issue, acting deputy chief of police Gary Gilliam said Wednesday. "It's enough of a public safety issue that we are diverting patrol services," he said.
On Wednesday, Anchorage Mayor Ethan Berkowitz said that a $5 million budget increase in funding to police and fire departments will help address the issue. The mayor's office has also hired a homelessness coordinator, Nancy Burke, who said in August that the Spice crisis is another reason to get homeless people into housing.
Meanwhile, the city is also looking to strengthen its own Spice ordinance -- perhaps making the sale and use a crime instead of a simple ticket.
What shape that may take is not yet finalized, but "other states have found a way to draft code that is broad enough to, they think, cover a wide variety of synthetics," city prosecutor Seneca Theno said. A similar ordinance in Alaska would give police more power to charge people criminally.
There's also a chance that existing Spice may fall under some criminal codes: Preliminary results suggest that a controlled substance has been found within Alaska Spice samples, Theno said. That would mean police would have much more power to attack the issue.
Anchorage is also hoping for help from the federal government. In late August, Theno reached out to the U.S. attorney's office. The feds may have more power to go after Spice criminally, as the federal controlled substances list is "a little longer and a little broader" than Alaska's, Theno said.
The prosecutors can also use other federal agencies, such as the DEA, the Postal Service, the FBI and the FDA, to tackle the problem, Theno said. It's not yet clear, though, whether the feds will intervene.
Meanwhile, emergency responders continue to combat Spice use as each case arises. "By end of the year we'll have a better idea if this is going to be the new norm or just … a passing trend," Schuenemann said.
And at Bean's, Boyd said he, too, feels like a medic. "I worked on one and saved his life out here in middle of the street. And he died a week later," Boyd said, referring to one of the seven Bean's clients who died over the summer.
"A lot of them left (Spice) alone and they've been encouraging others to leave it alone," Boyd said of the clients. "But you've just got some that are hardheaded and won't do it."
Photojournalist Marc Lester contributed to this story.